| 1. |
- Ebefors, Thorbjörn, et al.
(författare)
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A robust micro conveyer realized by arrayed polyimide joint actuators
- 1999
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Ingår i: Proceedings of the 1999 12th IEEE International Conference on Micro Electro Mechanical Systems. - 0780351940 ; , s. 576-581
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Konferensbidrag (refereegranskat)abstract
- A new micromotion system (micro-conveyer) based on arrays of movable robustsilicon legs has been developed and investigated. The motion is achieved by thermal actuation of polyimide joint actuators using electrical heating. Successful experiments on moving flat objects in the millimeter range with high load capacity have been performed. The conveyerconsists of a15×5 mm2 chip with 12 silicon legs each 500 μm long. The maximum load conveyed on the structure was 2000 mg. Conveyance velocities up to 12 mm/s have been measured. Accelerated life-time measurements demonstrate the long-term stability of the actuators. The function of the polyimide joint actuators is unaffected after more than 2×108 load cycles.
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| 2. |
- Ebefors, Thorbjörn, et al.
(författare)
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A robust micro conveyer realized by arrayed polyimide joint actuators
- 2000
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Ingår i: Journal of Micromechanics and Microengineering. - : IOP Publishing. - 0960-1317 .- 1361-6439. ; 10:3, s. 337-349
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Tidskriftsartikel (refereegranskat)abstract
- A new micro-robotic conveyance system based on arrays of movable robust silicon legs has been developed and investigated. Motion is achieved by thermal expansion in polyimide joint actuators using electrical heating. Successful experiments on moving and rotating flat objects in the millimeter range have been performed with high load capacity. The conveyer consists of a 15 x 5 mm(2) chip having 12 silicon legs, each with a length of 500 mu m. The maximum load conveyed on the structure was 3500 mg. Both transverse and rotational movements have been demonstrated experimentally. Conveyance velocities up to 12 mm s(-1) have been measured. Accelerated lifetime measurements demonstrate the long-term stability of the actuators. The functionality of the: polyimide joint actuators is unaffected after more than 2 x 10(8) load cycles.
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| 3. |
- Forslind, Kristina, et al.
(författare)
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Does digital X-ray radiogrammetry have a role in identifying patients at increased risk for joint destruction in early rheumatoid arthritis?
- 2012
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Ingår i: Arthritis Research & Therapy. - : Springer Science and Business Media LLC. - 1478-6362 .- 1478-6354. ; 14:5, s. R219-
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionThe aim of this study was to investigate the role of hand bone mineral density (BMD) loss analyzed with digital X-ray radiogrammetry (DXR) in early rheumatoid arthritis (RA) as a predictor for progression of joint damage.MethodsIn 379 patients with early RA, baseline and one-year hand BMD was measured with DXR and the hand bone loss (HBL) was analyzed using the smallest detectable change (HBLsdc) and tertiles (HBLtertiles). Joint damage in hands and feet were scored according to the Sharp van der Heijde (SHS) method at baseline and at one, two, five and eight years. At the same time-points Disease Activity Score (DAS28) was calculated and functional disability assessed. Rheumatoid factor (RF) and antibodies against cyclic citrullinated peptides (anti-CCP) were analyzed at baseline.ResultsSixty-six percent of the patients had hand BMD loss in the first year of RA determined by HBLsdc and 65% by HBLtertiles. Radiographic progression after two, five and eight years was associated with hand bone loss defined by HBLsdc. By HBLtertiles there were significant associations at all time-points except at eight years. The change in DXR at one year (ChDXR1yr) correlated significantly and inversely with the change in SHS (ChSHS) at two, five and eight years. Multivariate analysis showed that only change in SHS during the first year and the presence of anti-CCP were independent predictors of long-term progressive joint damage. If radiographic scores were not included, DXR-BMD loss was an independent predictor. Patients with great bone loss by HBLtertiles had significantly more often high disease activity after two years. However, neither bone loss by HBLsdc or HBLtertiles nor by ChDXR1yr was an independent predictor of remission after two, five and eight years.ConclusionsThis study confirms previous reports of an association of decrease in DXR-BMD during the first disease year with progression of radiographic joint damage over an extended period of time. This association was independent in a regression model only when radiological findings were excluded suggesting a possible predictive role of DXR-BMD in clinical practice when radiographic evaluation is not available. However, further studies are required before this can be established.
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| 4. |
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| 5. |
- Kälvesten, Johan, 1980-
(författare)
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Automatic image analysis for decision support in rheumatoid arthritis and osteoporosis
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Low-energy trauma and fragility fractures represent a major public health problem. The societal cost of the fragility fractures that occurred in Sweden 2010 has been estimated at €4 billion.In rheumatoid arthritis (RA), patient outcomes have improved greatly in recent years. However, the therapeutic decision making is still hampered by a lack of effective validated biomarkers. The cost of RA in Sweden 2010 has been estimated at €600 million, of which biologic drugs was €180 million.Digital X-ray radiogrammetry (DXR) is a method to measure bone mineral density (BMD) in the metacarpals of the hand. It can be applied opportunistically in several workflows where a person is already at an X-ray machine, including fracture repositioning follow up, mammography screening and hand imaging in RA. This thesis explored DXR-BMD as a marker to identify individuals who would benefit from anti-osteoporotic treatment, change rate of DXR-BMD as a biomarker in RA and under what conditions historical X-ray images can be used to estimate DXR-BMD. An automated method for measurement of joint space width in metacarpophalangeal and interphalangeal joints was also developed and evaluated as a biomarker in RA.Low DXR-BMD was predictive for hip fractures and predicted fragility fractures to a comparable degree as other BMD measurement sites. Rapid decrease of DXR-BMD was a strong and independent predictor for progression of radiographic damage in RA when manual radiographic progression scores were not available. Change of metacarpal joint space width was a statistically significant but weak predictor of joint space narrowing score progression. Guidelines and considerations for use of historical X-ray radiographs for DXR-BMD measurements in clinical trials have been developed and published.
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| 6. |
- Kälvesten, Johan, et al.
(författare)
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Digital X-ray radiogrammetry in the study of osteoporotic fractures: Comparison to dual energy X-ray absorptiometry and FRAX
- 2016
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Ingår i: Bone. - : ELSEVIER SCIENCE INC. - 8756-3282 .- 1873-2763. ; 86, s. 30-35
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Tidskriftsartikel (refereegranskat)abstract
- Osteoporosis is often underdiagnosed and undertreated. Screening of post -menopausal women for clinical risk factors and/or low bone mineral density (BMD) has been proposed to overcome this. Digital X-ray radiogrammetry (DXR) estimates hand BMD from standard hand X-ray images and have shown to predict fractures and osteoporosis. Recently, digital radiology and the internet have opened up the possibility of conducting automated opportunistic screening with DXR in post -fracture care or in combination with mammography. This study compared the performance of DXR with FRAX (R) and DXA in discriminating major osteoporotic fracture (MOF) (hip, clinical spine, forearm or shoulder), hip fracture and femoral neck osteoporosis. This prospective cohort study was conducted on 5278 women 65 years and older in the Study of Osteoporotic Fractures (SOF) cohort Baseline hand X-ray images were analyzed and fractures were ascertained during 10 years of follow up. Age -adjusted area under receiver operating characteristic curve (AUC) for MOF and hip fracture and for femoral neck osteoporosis (DXA FN BMD T -score <= -2.5) was used to compare the methods. Sensitivity to femoral neck osteoporosis at equal selection rates was tabulated for FRAX and DXR. DXR-BMD, FRAX (no BMD) and lumbar spine DXA BMD were all similar in fracture discriminative performance with an AUC around 0.65 for MOF and 0.70 for hip fractures for all three methods. As expected femoral neck DXA provided fracture discrimination superior both to other BMD measurements and to FRAX. AUC for selection of patients with femoral neck osteoporosis was higher with DXR-BMD, 0.76 (0.74-0.77), than with FRAX, 0.69 (0.67-0.71), (p < 0.0001). In conclusion, DXR-BMD discriminates incident fractures to a similar degree as FRAX and predicts femoral neck osteoporosis to a larger degree than FRAX. DXR shows promise as a method to automatically flag individuals who might benefit from an osteoporosis assessment (C) 2016 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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| 7. |
- Kälvesten, Johan, et al.
(författare)
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Feasibility, precision and validity of a novel fully automated quantitative method developed for measurement of digital joint space width in inflammatory arthritis
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- ObjectivesIn rheumatoid arthritis (RA) radiographic joint damage is a key long-term outcome and is often evaluated in clinical trials through the van der Heijde modified Sharp method which includes the joint space narrowing (JSN) score. The aim of this study was to investigate the feasibility, the precision and the validity of a novel fully automated method for quantifying joint space width (JSW) in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in order to develop a method for use in the clinic where manual scoring is usually not available.MethodsRadiographs from the SWEFOT trial were examined and processed for automated quantification of 1 year change (1yCh) in average JSW in MCP joints 2, 3 and 4 and proximal PIP joints 2 and 3. The relationship between change in JSW and change in JSN was studied using linear regression.Results1yCh in MCP234 and PIP23 was successfully measured in 119/119 and 117/119 patients respectively. Reproducibility expressed as coefficient of variation was 1.4% for MCP234 JSW and 1.6% for PIP23 JSW. There was a significant relationship between 1yCh in MCP234 JSW and 1yCh in JSN (r= -0.19, p=0.036). In contrast, 1yCh in PIP23 JSW was not independently significantly associated with 1yCh in JSN.Conclusion Automated measurement of change in MCP234 JSW was technically feasible and it was related to the change in JSN. Adding PIP23 JSW did not strengthen the association to JSN. We are continuing to study the possible utility of JSW in clinical trials and clinical practice.
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| 8. |
- Kälvesten, Johan, et al.
(författare)
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Potential sources of quantification error when retrospectively assessing metacarpal bone loss from historical radiographs by using digital X-ray radiogrammetry : an experimental study
- 2014
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Ingår i: Journal of clinical densitometry. - : Elsevier. - 1094-6950 .- 1559-0747. ; 17:1, s. 104-108
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Tidskriftsartikel (refereegranskat)abstract
- During the past 15 yr, digital X-ray radiogrammetry (DXR) has been used to measure metacarpal bone mineral density (BMD). BMD is often measured in existing cohorts where X-ray images were not acquired in accordance with the DXR imaging protocol (DIP). The purpose of the present study was to analyze how deviations from DIP in historical radiographs may affect the reproducibility of DXR-BMD measurements. Cadaver hand phantoms were used to conduct repeat measurements of deviations from DIP with respect to voltage, exposure, lateral displacement, supination, combination of lateral displacement and supination or rotation, extension of the wrist, and edge enhancement. Direct digital radiography (Aristos; Siemens Healthcare, Erlangen, Germany) was used for image acquisition and dxr-online (Sectra, Linkoping, Sweden) for DXR-BMD measurements. The influence of the tested deviations from DIP ranged from 0 to 32.5 mg/cm(2) (0-6.8%). On repetition with the same specimen, none of the deviations resulted in a within-specimen reproducibility error greater than 2 mg/cm(2) (0.4%, equivalent to a T-score of 0.042). Among the tested deviations, all except tube voltage had a magnitude greater than the normal measurement noise for the technique and must therefore be considered when planning a study based on historical images.
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| 9. |
- Mangnus, L., et al.
(författare)
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Bone mineral density loss in clinically suspect arthralgia is associated with subclinical inflammation and progression to clinical arthritis
- 2017
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Ingår i: Scandinavian Journal of Rheumatology. - : TAYLOR & FRANCIS LTD. - 0300-9742 .- 1502-7732. ; 46:5, s. 364-368
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Peripheral bone mineral density (BMD) may be decreased in early rheumatoid arthritis (RA) but it is unknown whether BMD loss emerges before arthritis is clinically apparent. We aimed to study whether BMD loss occurs in patients with clinically suspect arthralgia (CSA), and whether it is associated with progression to clinical arthritis and magnetic resonance imaging (MRI)-detected subclinical inflammation.Method: Patients with CSA had arthralgia for amp;lt;1year and were at risk of progressing to RA according to their rheumatologists. At baseline, a 1.5T MRI was performed of unilateral metacarpophalangeal, wrist, and metatarsophalangeal joints, and scored on synovitis, bone marrow oedema, and tenosynovitis;. summing these features yielded the total MRI inflammation score. Digital X-ray radiogrammetry (DXR) was used to estimate BMD on two sequential conventional hand radiographs (mean interval between radiographs 4.4months). The change in BMD was studied; BMD loss was defined as a decrease of 2.5mg/cm(2)/month. Patients were followed for arthritis development for a median of 18.4months.Results: In CSA patients (n=108), change in BMD was negatively associated with age (=-0.03, p=0.007). BMD loss in CSA patients was associated with arthritis development [adjusted for age hazard ratio (HR)=6.1, 95% confidence interval (CI) 1.7 to 21.4] and was most frequently estimated in the months before clinical arthritis development. The total MRI inflammation scores were associated with the change in BMD (adjusted for age =-0.05, p=0.047). The total MRI inflammation score and BMD loss were both independently associated with arthritis development (HR=1.1, 95% CI 1.1 to 1.2, and HR=4.6, 95% CI 1.2 to 17.2, respectively).Conclusion: In CSA patients, severe BMD loss is associated with MRI-detectable subclinical inflammation and with progression to clinical arthritis.
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| 10. |
- Platten, Michael, et al.
(författare)
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Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA
- 2017
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Ingår i: RMD Open. - : BMJ. - 2056-5933. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To study fully automated digital joint space width (JSW) and bone mineral density (BMD) in relation to a conventional radiographic scoring method in early rheumatoid arthritis (eRA). Methods Radiographs scored by the modified Sharp van der Heijde score (SHS) in patients with eRA were acquired from the SWEdish FarmacOTherapy study. Fully automated JSW measurements of bilateral metacarpals 2, 3 and 4 were compared with the joint space narrowing (JSN) score in SHS. Multilevel mixed model statistics were applied to calculate the significance of the association between ΔJSW and ΔBMD over 1 year, and the JSW differences between damaged and undamaged joints as evaluated by the JSN. Results Based on 576 joints of 96 patients with eRA, a significant reduction from baseline to 1 year was observed in the JSW from 1.69 (±0.19) mm to 1.66 (±0.19) mm (p<0.01), and BMD from 0.583 (±0.068) g/cm 2 to 0.566 (±0.074) g/cm 2 (p<0.01). A significant positive association was observed between ΔJSW and ΔBMD over 1 year (p<0.0001). On an individual joint level, JSWs of undamaged (JSN=0) joints were wider than damaged (JSN>0) joints: 1.68 mm (95% CI 1.70 to 1.67) vs 1.54 mm (95% CI 1.63 to 1.46). Similarly the unadjusted multilevel model showed significant differences in JSW between undamaged (1.68 mm (95% CI 1.72 to 1.64)) and damaged joints (1.63 mm (95% CI 1.68 to 1.58)) (p=0.0048). This difference remained significant in the adjusted model: 1.66 mm (95% CI 1.70 to 1.61) vs 1.62 mm (95% CI 1.68 to 1.56) (p=0.042). Conclusions To measure the JSW with this fully automated digital tool may be useful as a quick and observer-independent application for evaluating cartilage damage in eRA. Trial registration number NCT00764725.
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| 11. |
- Wevers-de Boer, K. V. C., et al.
(författare)
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Four-month metacarpal bone mineral density loss predicts radiological joint damage progression after 1 year in patients with early rheumatoid arthritis: exploratory analyses from the IMPROVED study
- 2015
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Ingår i: Annals of the Rheumatic Diseases. - : BMJ Publishing Group. - 0003-4967 .- 1468-2060. ; 74:2, s. 341-346
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Tidskriftsartikel (refereegranskat)abstract
- Aim To assess whether in early (rheumatoid) arthritis (RA) patients, metacarpal bone mineral density (BMD) loss after 4 months predicts radiological progression after 1 year of antirheumatic treatment. Methods Metacarpal BMD was measured 4 monthly during the first year by digital X-ray radiogrammetry (DXR-BMD) in patients participating in the IMPROVED study, a clinical trial in 610 patients with recent onset RA (2010 criteria) or undifferentiated arthritis, treated according to a remission (disease activity scoreless than1.6) steered strategy. With Sharp/van der Heijde progression greater than= 0.5 points after 1 year (yes/no) as dependent variable, univariate and multivariate logistic regression analyses were performed. Results Of 428 patients with DXR-BMD results and progression scores available, 28 (7%) had radiological progression after 1 year. Independent predictors for radiological progression were presence of baseline erosions (OR (95% CI) 6.5 (1.7 to 25)) and early DXR-BMD loss (OR (95% CI) 1.5 (1.1 to 2.0)). In 366 (86%) patients without baseline erosions, early DXR-BMD loss was the only independent predictor of progression (OR (95% CI) 2.0 (1.4 to 2.9)). Conclusions In early RA patients, metacarpal BMD loss after 4 months of treatment is an independent predictor of radiological progression after 1 year. In patients without baseline erosions, early metacarpal BMD loss is the main predictor of radiological progression.
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| 12. |
- Wilczek, Michael L., et al.
(författare)
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Can secondary osteoporosis be identified when screening for osteoporosis with digital X-ray radiogrammetry? : Initial results from the Stockholm Osteoporosis Project (STOP)
- 2017
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Ingår i: Maturitas. - : Elsevier. - 0378-5122 .- 1873-4111. ; 101, s. 31-36
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To identify causes of low age-adjusted bone mass at digital X-ray radiogrammetry (DXR) in individuals attending an osteoporosis screening program. Study design: In a descriptive observational cohort study, women aged 40-75 years who attended a general mammography screening program had their bone mass investigated with DXR and answered a questionnaire regarding several clinical risk factors for osteoporosis. Each month the 2% with the lowest Z-scores were selected for further clinical examination with DXA of the hip and lumbar spine and pre-defined blood tests. Main outcome measure: Causes of secondary osteoporosis determined by clinical and laboratory evaluation. Results: 14,783 women attended mammography screening and had their bone mass evaluated. In total, 327 women had a low DXR BMD and 281 accepted further DXA examination. Of these, 93 (33.1%) had osteoporosis. The diagnosis was new in 79 cases (84.9%) and in 32 (34.4%) a potential underlying cause was identified. Primary hyperparathyroidism was found in 8.6% and secondary hyperparathyroidism in 13.5%. Several self reported risk factors for osteoporosis, including rheumatic disease, insulin-treated diabetes, cortisone treatment, smoking, reduced mobility, hyperparathyroidism, and malabsorption, were significantly more common among those selected for DXA referral than in the total cohort. For example, rheumatic disease and insulin-treated diabetes were reported 3.4 and 2.3 times as often, respectively. Conclusion: The prevailing potential cause of secondary osteoporosis according to DXR was primary and secondary hyperparathyroidism. Most of the women with these conditions were previously undiagnosed, indicating that further follow-up of patients with low age-adjusted DXR BMD is justified.
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| 13. |
- Wilczek, M L, et al.
(författare)
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Digital X-ray radiogrammetry of hand or wrist radiographs can predict hip fracture risk-a study in 5,420 women and 2,837 men
- 2013
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Ingår i: European Radiology. - : Springer Verlag (Germany). - 0938-7994 .- 1432-1084. ; 23:5, s. 1383-1391
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Tidskriftsartikel (refereegranskat)abstract
- To assess whether digital X-ray radiogrammetry (DXR) analysis of standard clinical hand or wrist radiographs obtained at emergency hospitals can predict hip fracture risk. less thanbrgreater than less thanbrgreater thanA total of 45,538 radiographs depicting the left hand were gathered from three emergency hospitals in Stockholm, Sweden. Radiographs with insufficiently included metacarpal bone, fractures in measurement regions, foreign material or unacceptable positioning were manually excluded. A total of 18,824 radiographs from 15,072 patients were analysed with DXR, yielding a calculated BMD equivalent (DXR-BMD). Patients were matched with the national death and inpatient registers. Inclusion criteria were age a parts per thousand yen 40 years, no prior hip fracture and observation time andgt; 7 days. Hip fractures were identified via ICD-10 codes. Age-adjusted hazard ratio per standard deviation (HR/SD) was calculated using Cox regression. less thanbrgreater than less thanbrgreater than8,257 patients (65.6 % female, 34.4 % male) met the inclusion criteria. One hundred twenty-two patients suffered a hip fracture after their radiograph. The fracture group had a significantly lower DXR-BMD than the non-fracture group when adjusted for age. The HR/SD for hip fracture was 2.52 and 2.08 in women and men respectively. The area under the curve was 0.89 in women and 0.84 in men. less thanbrgreater than less thanbrgreater thanDXR analysis of wrist and hand radiographs obtained at emergency hospitals predicts hip fracture risk in women and men. less thanbrgreater than less thanbrgreater thanKey Points less thanbrgreater than less thanbrgreater thanDigital X-ray radiogrammetry of emergency hand/wrist radiographs predicts hip fracture risk. less thanbrgreater than less thanbrgreater thanDigital X-ray radiogrammetry (DXR) predicts hip fracture risk in both women and men. less thanbrgreater than less thanbrgreater thanOsteoporosis can potentially be identified in patients with suspected wrist fractures. less thanbrgreater than less thanbrgreater thanDXR can potentially be used for selective osteoporosis screening.
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| 14. |
- Wilczek, Michael L., et al.
(författare)
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Mammography and Osteoporosis Screening-Clinical Risk Factors and Their Association With Digital X-Ray Radiogrammetry Bone Mineral Density
- 2015
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Ingår i: Journal of clinical densitometry. - : Elsevier. - 1094-6950 .- 1559-0747. ; 18:1, s. 22-29
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to study the association between digital X-ray radiogrammetry (DXR) T-score and clinical risk factors for osteoporosis. Women were recruited 2 d per wk at a single mammography screening center between year 2010 and 2012. Included women answered a questionnaire about risk factors for osteoporosis, and a radiograph of the nondominant hand was obtained for DXR analysis. Univariate associations between DXR T-score and risk factors were examined. A generalized linear regression model was fitted to independent variables with univariate associations at p less than 0.05. The multivariable model was reduced through manual backward elimination, with p greater than 0.1 as the exclusion criterion. Seventy-six percent of the women chose to participate in the study (n = 8810). The difference in number of daily mammograms performed on study vs nonstudy days was not significant. All univariate associations between DXR T-score and potential risk factors were highly significant. The multivariable model included height, weight, age, right-handedness, menopause before age 45, alcohol consumption, cortisone treatment, rheumatic disease, and age x smoking status. The coefficient of determination of the model was 0.37. The association between risk factors for osteoporosis and DXR T-score is similar to previously reported associations with dual-energy X-ray absorptiometry.
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| 15. |
- Wilczek, M, et al.
(författare)
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Predicting hip fracture risk with hand or wrist radiographs using digital X-ray Radiogrammetry
- 2012
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Ingår i: Bone. - : Elsevier. - 8756-3282 .- 1873-2763. ; 50:Supplement 1, s. S65-S65
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Tidskriftsartikel (refereegranskat)abstract
- Abstract: Background: More than 50% of patients diagnosed with osteoporosis after a fracture have had at least one previous fracture. Despite an established relationship between bone mineral density (BMD) and fracture risk, as well as proven effective pharmacological treatment, there is still no routine for screening for osteoporosis. Digital X-ray Radiogrammetry (DXR) analysis provides a simple way to obtain a BMD measurement. However, there is a need for larger studies evaluating the relationship between BMD obtained through DXR and future fracture risk. If such a relationship is strong enough, it should be possible to find osteoporotic patients already at the time of the first fracture by analyzing hand X-ray images with DXR. Aim: To evaluate if conventional radiographs can be used to estimate future hip fracture risk with DXR analysis. Method and materials: After receiving approval from the local ethical committee, all radiographs depicting the left hand were collected from three emergency hospitals in Stockholm, Sweden (n = 45,538). Radiographs with insufficiently depicted metacarpal bone, foreign material such as fixation pins, unacceptable positioning of the metacarpals or fractures in the measurement regions, were manually excluded. 18,824 radiographs from 15,072 unique patients were considered suitable for DXR analysis. These patients were matched with the death and inpatient registers found at the Swedish National Board of Health and Welfare. Exclusion criteria were age < 40 years (n = 6,611) and prior hip fracture (n = 199). ICD-10 codes were used to identify hip fractures, including only patients coded for both diagnosis and adequate intervention. Results: 5420 women and 2842 men met the inclusion criteria. Average observation time was 3 years and 3 months, resulting in a total observation time of 27,072 person years. In total 122 patients had a hip fracture after their radiograph of the hand or wrist. Patients who suffered from a hip fracture had a significantly lower BMD than that of non-fractured patients when adjusted for age (0.53 g/cm2, SD 0.08 versus 0.42 g/cm2, SD 0.05 in females and 0.63 g/cm2, SD 0.07 versus 0.54 g/cm2, SD 0.09 in males; p < 0.0001, both). The age-adjusted RR/SD for hip fracture was 2.52 in females and 2.08 in males. The AUC was 0.89 in female and 0.84 in male. Conclusion: DXR analysis of wrist and hand radiographs obtained at emergency hospitals in Sweden predicts hip fracture risk in women and men.
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